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Saturday, November 12, 2016
Achilles Tendon Rupture: Make Sure To Check Flexibility at each Visit
I saw a patient yesterday that is now 5 and one half months post achilles tendon rupture. We decided to treat her without surgery and she is doing great. The purpose of this post is to mention the very important point to make sure the achilles flexibility is measured at each visit. With conservative treatment of achilles tendon ruptures, you have to err on the side of tightness initially. You tend to see however a good improvement with walking outside the removable boot between 4 to 6 months with the goal being 10 degrees ankle dorsiflexion with the knee straight, and 15 degrees with the knee bent. So, I was a little surprised when she had -4 degrees straight and 6 degrees bent yesterday. I have attached my video below on this measurement. Last time I measured her 3 weeks ago she was at 2 degrees and 5 degrees. So, there was a little soleal gain. Since the tightness can lead to re-tearing, I immediately put her on pain free stretching of both parts of the achilles 4 times a day with a quick check next week while she is in physical therapy. She is one of the patients that develops strength quickly, but tightness can develop even faster. I have a video on the blog on appropriate achilles stretching, and in this vulnerable state do not recommend negative stretching where the heel falls off a stair or ledge of some kind.